Medicare contracting reform of the Medicare fee-for-service program's administrative structure was authorized by the Medicare Prescription Drug, Improvement and Modernization Act of 2003 (MMA). As required, the Centers for Medicare & Medicaid Services (CMS) has been replacing fiscal intermediaries and carriers with new contract entities called Medicare Administrative Contractors (MACs). MACs will service both Part A and Part B providers for designated territories or jurisdictions.
Iowa is part of the Jurisdiction 5 (J5) MAC. On September 5, 2007, CMS announced it had awarded the contract for the J5 MAC to Wisconsin Physicians Service (WPS) Medicare. WPS Medicare will be responsible for both the Part A and Part B workload in the states of Iowa, Kansas, Missouri and Nebraska. Iowa Part B transitioned to WPS effective February 1, 2008, while Iowa Part A transitioned May 1, 2008. Visit the WPS Medicare Web site.
MD orders required for lab services
WPS Medicare has identified a recent increase in the number of errors attributed to lack of physician orders for diagnostic laboratory services billed. In response to this, WPS Medicare has posted an article on its Web site entitled, "CERT Alert: MD Orders Required for Laboratory Services." The article is available at: www.wpsmedicare.com/mac/publications/cert_alert.pdf.
If you receive a request for medical records from the Comprehensive Error Rate Testing (CERT) contractor or your local Medicare contractor, it is critical that the physician orders for all laboratory services or any other service that requires an ordering physician be included. Without the orders, the services will be determined to be medically unnecessary and payment for these services will be rescinded.